CMS 146 Appropriate Testing for Children with Pharyngitis

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Overview

This measure reports the percentage of encounters that involved patients who were 3-18 years old when diagnosed with pharyngitis. To qualify, patients must have been prescribed an antibiotic and received a group A streptococcus (strep) test for the episode.

At a Glance

eMeasure ID	CMS146v8
NQF	N/A
Used For?	Medicaid PI/Stage 3, MIPS (Quality)
Domain	Efficiency and Cost Reduction
MIPS Quality ID	66
MIPS Measure Type	Process
MIPS High Priority?	Yes

When documenting a visit in Prime Suite, the best practice is to include only one encounter code per visit. If a visit is associated with more than one encounter code, the QRDA I files you export from PSR 2020 may contain incorrect denominator counts. For 2020 reporting, this affects CMS 146 and CMS 154.

Measure Specification and Value Sets

You should be familiar with this measure’s specification, Value Sets, and direct reference codes (if applicable). Refer to Downloading Measure Specifications and Value Sets for more information. Measure help now includes hyperlinks to the Value Sets used by this measure. You must be registered for a UMLS license and signed in to your account to see this content.

Identifying Event Times

See Identifying Event Times for important information about the logic this dashboard uses.

Amending Signed Notes

As a best practice, Notes should not be signed until they are finalized. Amending a signed Note (by making changes to it in Prime Suite and then re-saving it) will change a patient’s qualification for this measure. Re-signing the amended Note may allow the patient to qualify again, but only if it is re-signed during the time period required by the measure.

Documenting Recorded Medications in Prime Mobile

If using Prime Mobile to document a recorded medication, you must enter a non-zero duration. Entering a duration ensures the medication's end date calculates properly and that the medication can qualify for eCQMs. Otherwise, Prime Mobile defaults the medication's end date to midnight of the date recorded. Since this can cause the medication’s end date and time to occur before its start date and time, the medication would not count towards any eCQMs looking for active medications.

Measure Calculations

Initial Population	Children 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit
Denominator	Initial Patient Population
Numerator	Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis

Measure Details

Initial Population/Denominator

Encounters are counted in the denominator if they involved patients who meet each of the following:

1.

They were 3-17 years old at the beginning of the measurement period. Patients who turn 18 years old during the measurement period will qualify. Age is based on the date of birth (DOB) entered on the Information page.

2.

They had at least one non-voided face-to-face encounter during the measurement period. This must be documented in the Plan or E&M section of a Note using a code from one of the following Value Sets:

• Discharge Services- Observation Care
• Emergency Department Visit
• Home Healthcare Services
• Hospital Observation Care - Initial
• Medical Disability Exam
• Office Visit
• Outpatient Consultation
• Preventive Care Services - Established Office Visit, 18 and Up
• Preventive Care Services - Group Counseling
• Preventive Care Services - Other
• Preventive Care Services, Initial Office Visit, 0 to 17
• Preventive Care Services-Individual Counseling
• Preventive Care Services-Initial Office Visit, 18 and Up
• Preventive Care, Established Office Visit, 0 to 17

3.

They had an active diagnosis of pharyngitis or tonsillitis during the visit that qualified them for criteria #2. This must be documented using a code from one of the following Value Sets: Acute Pharyngitis or Acute Tonsillitis. This must be documented in the Assessment section of Note.

4.

They were prescribed a pharyngitis antibiotic during, or up to three days after, the visit that qualified them for criteria #2. The prescription must meet both of the following:

a.

It was documented using a code from the Antibiotic Medications for Pharyngitis Value Set. This documentation must be recorded in the Plan section of a Note or on the Medication List.

b.

It was e-prescribed or printed.

Denominator Exclusions

Encounters are removed from the denominator if they involved patients who meet either of the following. Select a link for additional information.

• They received hospice care.
• They had a prior prescription for antibiotics.
• They had a diagnosis of a competing upper respiratory condition.

Hospice Care

Patients will be excluded from the denominator if they received hospice care. This must be documented with a vocabulary term in the Results or in a Flowsheet. This documentation must show one of the following:

• They were discharged from the hospital into hospice care during the measurement period. This must be documented with a vocabulary term using a parent code from the Encounter Inpatient Value Set and a child code using either of the following SNOMEDCT version 2019-05-10 direct reference codes:
  • 428371000124100, indicating a patient was Discharged to a health care facility for hospice care.
  • 428361000124107, indicating a patient was Discharged to home for hospice care.
• They received hospice care. This must be documented with a vocabulary term in a Flowsheet using a code from the Hospice care ambulatory Value Set. The date the provider enters this documentation must occur during the measurement period.
• They had an order for hospice care. This must be documented in the Plan or Results section of a Note using a code from the Hospice care ambulatory Value Set. This order must have been created during the measurement period.

Prior Prescription for Antibiotics

Patients will be excluded from the denominator if they had a prior prescription for antibiotics active in the 30 days prior to the visit that qualified them for denominator criteria #2. This must be documented using a code from the Antibiotic Medications for Pharyngitis Value Set in either the Plan section of a Note or the Medication List.

If using Prime Mobile to document a recorded medication, you must enter a non-zero duration for the medication to qualify. See Documenting Recorded Medications above for more information.

Competing Diagnosis for Upper Respiratory Infection

Patients will be excluded from the denominator if they had a diagnosis of a competing upper respiratory condition, starting 3 days or less after the start of the encounter that qualified for the Initial Patient Population Criteria #2. This must be documented using a code from Competing Conditions for Respiratory Conditions Value Set.

Numerator

Encounters are counted in the numerator if they involved patients who were given a Group A Streptococcus test during the 7-day period that begins 3 days prior to the visit that qualified them for denominator criteria #2, includes the day of that visit, and ends 3 days after that visit. This must be documented with a vocabulary term using a code from the Group A Streptococcus Test Value Set. This documentation can appear in the Results or in a Flowsheet.

Numerator Exclusions

Not Applicable

Denominator Exceptions

None